DEAR DR. DONOHUE: More than a year ago, I was diagnosed as having very low testosterone. The doctor had me take injections every two weeks. Four weeks into the program, I experienced a sudden weight gain, and my legs and feet were so swollen that I would have had to go barefoot were it not for an old pair of flip-flops. I didn’t take any more injections. My feet did not fit into my shoes. I next tried another testosterone supplement, only in the form of a cream. The swelling quickly returned. I am not a doctor, but I think low testosterone would explain many changes in my life. I would like to take the hormone treatments, but not if I’m going to swell up. Can you help? I am 63. — K.M.

ANSWER: If I were your doctor, I would be most reluctant to put you back on testosterone in any form. This hormone can induce body retention of sodium and water, and I believe that’s why you experienced the swelling you described. You retained sodium and water. For most men, this retention of sodium and water is a minor problem. For you, it is a major one.

For some men whose production of testosterone has waned considerably, replacement therapy preserves muscle tissue, enhances sexual function and slightly reduces body fat. It’s not a cure-all for aging. About 20 percent of men in their 60s have low testosterone levels. Only a small number receive replacement treatment. The rest do well without it.

You realize that testosterone has its downsides. It can promote enlargement of the prostate gland. It might stimulate the growth of indolent nests of prostate cancer. It encourages an increased production of red blood cells, which can give men trouble. It often leads to the growth of the male breast.

I wish you had been more specific about the “many life changes” you ascribe to low testosterone. If you mean attaining an erection, other medicines can overcome that problem. Exercise reverses the muscle loss that comes with age. If you are overweight, obesity accelerates testosterone decline, something that weight loss can remedy.

DEAR DR. DONOHUE: A few days ago, I read your column about sepsis in hospitals. Do you think it would help if medical personnel would keep their hands out of their hair? I have noticed that they wash their hands and then proceed to move their hair. Is this sanitary? — C.L.

ANSWER: For readers who missed the sepsis discussion, sepsis is the invasion of the bloodstream by bacteria and bacteria-made poisons. Blood pressure drops, temperature rises, the heart beats rapidly, and breathing becomes labored and shallow. If antibiotics and medicines to boost blood pressure are not given quickly, organs fail and death is almost certain. Death is still possible even when these measures are taken.

All medical personnel ought to wash their hands routinely after examining patients. I’m not positive how much of a menace hair-touching is in spreading germs. But you have a point. Anything that can cut down on the transfer of germs from one patient to the next is worthy of consideration.

DEAR DR. DONOHUE: I have been watching your column for at least a month for a response to my request for information on pemphigoid. My daughter suffers from it. Please do give me your input on this disease. — C.L.

ANSWER: Was it your daughter who wrote the material you enclosed on mucous membrane pemphigoid? If it was, she did a terrific job, and I can’t add much to what she wrote.

It is an autoimmune disease, one of those illnesses brought on by a suicidal attack of the immune system on its own tissues. In this case, the tissues are the lining of the mouth and throat, the covering of the eyes and sometimes the genital coverings. The attack results in blisters. What made the immune system turn on its own body is an unanswered question.

If the eyes are involved, an eye doctor should be part of the treatment team. A dermatologist most often takes care of the other sites of mucous membrane pemphigoid.

Ointments of the more powerful cortisone preparations are used to control outbreaks. Sometimes one of the cortisone drugs has to be given by mouth.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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